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Understanding Hepatitis Part 1

World Hepatitis Day is July 28th and we wanted to share with you some information about this very misunderstood disease.

What Is hepatitis?

Hepatitis is an inflammation of the liver caused by a hepatitis virus.

An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected. Most do not know HOW they were infected. About 80,000 new infections occur each year.

There are several types of viral hepatitis infections. The most common types of viral hepatitis in the U. S. are hepatitis A, B, and C. In recent years, hepatitis D and E viruses also have been identified. Related health issues affecting the liver are cirrhosis and liver cancer.

How do you get hepatitis?

Hepatitis A is transmitted through fecal contaminated food or water and anal/oral contact.

Transmission of hepatitis B (HBV) and C (HCV) involves contact with infected blood and body fluids. HBV is transmitted by infected body fluid. HCV is a blood born virus and is transmitted blood to blood. In some cases it is impossible to trace the source of a hepatitis infection.

Can someone visit me if they have hepatitis?

It is perfectly safe to visit someone with hepatitis. Hepatitis is not transmitted through casual contact. It is OK to shake hands with, hug, or kiss someone who is infected with viral hepatitis.

Can hepatitis be sexually transmitted?

Yes, hepatitis B is often sexually transmitted. HBV is found in blood, semen, and vaginal fluids.

The virus is 100 times more infectious than the HIV virus. Sexual partners of an infected person should practice safe sex. Partners not infected should get vaccinated for hepatitis B. (Those who have recovered from HBV are immune.)

Hepatitis C is not easily transmitted through sexual contact; researchers are uncertain how often transmission occurs through sex.

Hepatitis A may be spread through anal/oral contact during sex.

Is treatment available for hepatitis patients?

  • Hepatitis A: no treatment for hepatitis A (HAV), however 99% of the time HAV will clear up over a period of a few weeks to months.

  • Hepatitis B: treatment for chronic hepatitis B usually consists of Alpha interferon and lamivudine. These drugs are effective in up to 40% of patients.

  • Hepatitis C: treatment for HCV will be interferon, ribavirin, and teleprevir or boceprevir. Currently these are the recommended drugs. Interferon can be taken alone or in combination with Ribavirin. Combination therapy is currently the treatment of choice.

  • Chronic hepatitis D is usually treated with pegylated interferon, although other potential treatments are under study.

  • Hepatitis E usually resolves on its own over several weeks to months.

Hepatitis A (HAV)

Hepatitis A is the most common of the two enterically (relating to, or being within the intestine) transmitted hepatitis viruses (hepatitis A virus and hepatitis E virus) in the U.S. and is one of the two vaccine-preventable hepatitis infections (hepatitis A and B). In children the infection is usually mild and without symptoms. However, in adults the severity generally increases with increasing age. Nonetheless, full recovery is expected in about 99% of all infections. HAV infection usually resolves on its own over several weeks, but occasionally relapses occur.

Hepatitis A does not lead to chronic hepatitis.

Hepatitis A is spread primarily through person-to-person contact, or via food or water contaminated by feces from an infected person. In rare cases, it can be spread through contact with infected blood. Basic precautions like washing hands with soap and water following bowel movements and before food preparation can reduce the incidence. Hepatitis A is prevented through vaccination. The Centers for Disease Control and Prevention (CDC) recommend hepatitis A vaccination for children aged 12 to 23 months and for adults who are at high risk for infection. Following the initial dose, a booster dose is given 6-12 months later. Treatment with immune globulin can provide short-term immunity to hepatitis A when given before exposure or within 2 weeks of exposure to the virus but vaccination is preferred since it provides long-term immunity lasting at least 20 years.

If you are traveling to any countries with poor sanitary conditions then you should get vaccinated at least one month before departure. You should also avoid tap water when traveling internationally and practice good hygiene and sanitation. People who should be vaccinated against hepatitis A include:

  • Travelers (tourists, business, missionaries, military, peace-keepers)

  • Users of illegal injected drugs

  • Native peoples of America

  • Restaurant workers and food handlers

  • Children living in communities that have high rates of hepatitis

  • Children and workers in day care centers

  • People engaging in anal/oral sex or with STDs or HIV

  • People with chronic liver disease

  • If you eat raw shellfish frequently, ask your physician about being vaccinated.

  • Laboratory workers who handle live hepatitis A virus.

Hepatitis B is a vaccine-preventable bloodborne infection. It is a serious viral disease that infects the liver. While the hepatitis B virus (HBV) doesn’t directly damage the liver, it is the body’s immune response to the virus that results in liver injury. Among adults with acute hepatitis B less than 2% fail to clear the virus within six months after infection and develop chronic Hepatitis B infection. To offer a comparison, about 80% of infected newborns and as many as 20% of children under the age of 5 develop persistent infection. Patients with acute hepatitis B must be followed carefully to identify those who have recovered spontaneously and those in whom chronic infection may require specific antiviral drug treatment. Treatment is reserved for those patients in whom viral levels are increased above a specific level and liver enzymes elevations are present. Other patients, for example, so-called inactive carriers with low levels of virus and normal liver enzymes are not currently treated.

In the U.S. the disease is spread predominantly through sex with an infected person, from mother to child during childbirth, (regardless if the delivery is vaginal or through Caesarean section), and through contact with infected blood or body secretions among injection drug users, health care workers, first-responders, and others at risk of exposure. Screening of Asian-Americans for evidence of HBV is recommended because mother to child transmission was common in Asia and other parts of the world prior to the development of immunization programs. Vaccination provides the safest and most effective protection against hepatitis B for at least 15 years and possibly much longer. Currently, the Centers for Disease Control and Prevention (CDC) recommend that all newborns and individuals up to 18 years of age as well as adults at a high risk of infection be vaccinated. They also recommend that previously unvaccinated patients with diabetes, age 19 to 59 years, should be vaccinated since such individuals appear to be at increased risk.

Everyone who handles blood or blood products in their daily work should be vaccinated. Three injections over a 6-12 month period are required to provide full protection.

Infants born to infected mothers should receive hepatitis B immune globulin and the hepatitis B vaccine within 12 hours of birth to help prevent infection. Two additional doses of vaccine should be administered at 1 and then at 6-12 months of age. There is increasing evidence that for pregnant women with high levels of HBV, treatment with an oral antiviral at the end of the second or beginning of the third trimester until delivery will reduce the risk that the immunized baby will be infected.

People who develop acute hepatitis B are generally not treated with antiviral drugs because the disease often resolves on its own.

Infected newborns are most likely to progress to chronic hepatitis B, but by young adulthood, most people with acute infection recover spontaneously. Severe acute hepatitis B can be treated with an oral antiviral drug but available data on effectiveness are conflicting and those with acute liver failure are candidates for liver transplantation.

For the treatment of chronic hepatitis B two oral drugs – tenofovir and entecavir – and an injected drug, pegylated interferon are available and considered first-line options. Older drugs, such as lamivudine, telbivudine, and adefovir, are no longer favored. These treatments suppress HBV and improve outcomes. However, treatment is not a cure and small amounts of HBV may persist in the liver for decades.

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